Nutrition - Who really Cares?

Ask an Extension home economist to name one of the most popular programs and many will respond with a food or nutrition topic. Today, there's an increasing emphasis on nutrition and healthful eating habits. Yet a walk down Main Street, U.S.A., quickly reveals that we're an overweight population. Do people really not know what foods they need to eat; or don't they care about nutrition?

A 1978 national survey by Louis Harris and Associates found that 67% of the adult population recognized they'd be healthier if they ate better.¹ Most Americans, however, aren't willing to limit their food choices. Some who do may be concerned about weight control or short-term health effects. Others may view a good diet as a preventive measure with longer-term health benefits.

In 1980, to determine the attitudes, beliefs, and social pressure influencing the food behavior of women, we conducted a national telephone survey. Women between the ages of 20 and 59, not pregnant or nursing, were interviewed. Women were studied because they tend to have more nutrition deficiencies than men. By understanding what motivates the food preparer, who's generally the woman, we may better understand the food behavior of the American family. And, women remain the traditional audience for Extension home economics programming.

Preventive Health Behavior

Nutrition education has emphasized good dietary habits as preventive health behavior.² Control of food choices is presently linked to long-term health benefits, and good diet is promoted as a preventive health behavior.

Rosenstock's Health Belief Model provides a context for viewing dietary control as preventive health behavior. Becker and Maiman's revised Health Belief Model formed the theoretical framework for this study.³ Components of this model were expected to differentiate women who controlled their eating and women who didn't.

Categories of Eating Behavior

In a national study of 1,188 Americans over the age of 18, Yankelovich, Skelly and White, Inc., found that "three out of four consumers agree that they either eat what they like and don't worry (17%), or at best, try for a balanced diet, but don't make a big deal of it (59%)."⁴ The second group most clearly matches the characteristics of the general public, including their knowledge of nutrition.⁵ This supports the idea that most Americans prefer not to be concerned about nutrition or eating a balanced diet.

Given these findings, and evidence gathered from pretesting, four eating behavior categories became obvious among the women interviewed for this telephone survey study. These categories are detailed in Table 1.

Findings

Significant differences were found among the four behavioral categories on all of the components, with the exception of the use of vitamins, minerals, or other food supplements. In other words, the analyses indicated that the classification of women as Unconstrained Eaters, Unconstrained Eaters with Diet History, Constrained Eaters with Weight Concerns, and Constrained Eaters with Health Concerns had created groups with significantly different eating habits.

The woman's perceived susceptibility to gaining weight if she didn't eat carefully produced the strongest difference among the eating behavior categories. The second most important component was the woman's present weight compared to her ideal weight. Next was social pressure to lose weight, followed by avoidance of foods with sugar.

Unconstrained Eaters

Another way to interpret the results is to consider the profiles of the four groups. The results suggest that most Unconstrained Eaters, unlike the other three groups, didn't have weight problems. Nearly two-thirds of these women considered themselves to be near or under their ideal weight. They had very little social pressure to change the way they ate. They worried least about sugar and the impact of what they ate on their future health. They were also the least likely to search for nutritional information. In other words, they didn't really care about nutrition.

Constrained Eaters with Health Concerns

The Constrained Eaters with Health Concerns were the only group of the four in which a majority indicated a high concern for their own nutrition and believed their diet would have an effect on their future health. They were the most likely of the groups to search for nutrition information and to avoid sugar and salt. They also indicated they were susceptible to gaining weight. A majority reported they were over their ideal weight. This group also most frequently indicated they'd received and responded to social pressure to change their diet (in other ways than to lose weight). These women did care about nutrition.

Constrained Eaters with Weight Concerns

The most distinctive characteristic of the Constrained Eaters with Weight Concerns was that 87% of them reported they were over their ideal weight and nearly 80% indicated they were very likely to gain weight if they weren't careful what they ate. A higher percentage of these women than any of the others reported they received and responded to social pressure to lose weight.

Unconstrained Eaters with Diet History

The Unconstrained Eaters with Diet History were the least distinctive group. These women had the lowest level of concern about their own nutrition and about avoiding salt. They were most similar to the Constrained Eaters with Weight Concerns with respect to searching for nutrition information They were most similar to the Constrained Eaters with Health Concerns about susceptibility to gaining weight, the degree to which they believed they were overweight, and the extent to which they'd experienced social pressure to lose weight.

Implications for Extension

This study has several implications for Extension home economists. Often we assume that correct information will provide a solution to the problem. Few overweight women are ignorant of the consequences of eating foods with lots of sugar, but many continue to do so. Information can be useful in creating an awareness or concern for nutrition. However, a concern for nutrition doesn't always result in healthful eating habits.

Therefore, Extension home economists need to go beyond teaching the four food groups and issuing a plea for good nutrition. About half the women in the study were classified into the two categories of unconstrained eaters. Of these women, over 75% reported being very or somewhat concerned about their own nutrition. Yet, they searched little for nutrition information, didn't make much effort to follow recommended eating practices, and ate whatever they wanted. These two groups of women did have weight problems. So do they really care about nutrition?

The two categories of constrained eaters have differing attitudes and beliefs, producing differing styles of eating behavior. Therefore, Extension home economists shouldn't assume that people with weight problems will respond to the health implications of nutrition. Their primary concern is to lose their excess pounds, or avoid gaining any more. Overweight women may have some health concerns, but their main worry is their weight, not their health.

Similarly, the Constrained Eaters with Health Concerns were motivated either by their present health condition or by trying to avoid future health problems. They were somewhat concerned with weight, as evidenced by the majority believing that they'd gain weight if they weren't careful what they ate. A concern for health may include a concern for weight and nutrition.

Through this study, it became evident that a concern for health produced an active interest in nutrition. Many Extension home economists maintain that a concern for nutrition will produce an interest in health. The reverse may be true. A concern for health appears to motivate a person to care about and become active in her own nutrition and food behavior.

Almost 35% of the women were classified as Constrained Eaters with Weight Concerns, while about 15% of the women constrained their eating due to health concerns. These two groups demonstrate that a concern for weight or a concern for health does affect eating habits. The implication for Extension home economists suggests delineating audiences as to weight or health concerns. These two groups have distinct attitudes and beliefs producing distinct behaviors and concerns. Effort should be made to pre-sort audiences according to their concerns before an educational program.

A crisis situation, such as overweight or diet-related health condition, is motivational in constraining one's eating. Educational programs directed to the Constrained Eaters with Weight Concerns or with Health Concerns would be a starting point for nutrition education. The study shows that these two groups of women try to constrain their eating. Therefore, if funding was limited, these two groups could become priority audiences.

Since dietary habits are formed at an early age, the link to weight and particularly health could be stressed to children. They may not fully understand some of the health problems, but merely stating that some foods are good for you and some foods are bad for you is unlikely to change food habits.

As for teenagers and adults, some possible linkages between food, health, and weight include acne, overweight, heart disease, and diabetes. Such conditions may be of concern to these people. Focusing on these types of conditions, as opposed to the traditional deficiency diseases, would be more appropriate to today's lifestyle.

Extension home economists won't change all those who don't care about nutrition, but we can place the responsibility of one's health more firmly in a person's mind. The important issue is to make a strong link between the foods eaten everyday and one's present and future health and weight.

The study also documents the importance and effectiveness of social pressure in constraining one's eating habits. Those women constraining their eating were receiving and responding to more social pressure. Therefore, peer support groups could play an important role in educational efforts. The effectiveness of peer support weight reduction groups has been recognized for years. However, healthrelated support groups are a newer concept. Extension home economists could endorse and promote the establishment of groups for concerns such as diabetes and heart disease.

Extension home economists need to do more than teach basic nutrition. Some women don't care about nutrition, some want to lose weight, some are concerned about their health, some relate health and nutrition. Programs directed at audiences with specific motivations should result in more effective education.

Footnotes

1. Louis Harris and Associates, Inc., Health Maintenance (New York: Louis Harris and Associates, Inc., 1978), p. vi.
2. Irwin M. Rosenstock, "The Health Belief Model and Preventive Health Behavior," Health Education Monographs, II (Winter, 1974), 354.
3. Marshall H. Becker and Lois A. Maiman, "Sociobehavioral Determinants of Compliance with Health and Medical Care Recommendations," Medical Care, XIII (January, 1975), 20.
4. Yankelovich, Skelly and White, Inc., Nutrition: A Study of Consumers' Attitudes and Behavior Toward Eating at Home and Out of Home (New York: Yankelovich, Skelly and White, Inc., 1978), p. 19.
5. Ibid., p. 93.